Provider Demographics
NPI:1265786651
Name:SHAMROCK BEHAVIORAL HEALTH SERVICES OF OKLAHOMA, LLC
Entity type:Organization
Organization Name:SHAMROCK BEHAVIORAL HEALTH SERVICES OF OKLAHOMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:405-464-3279
Mailing Address - Street 1:12309 NEWGATE DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6426
Mailing Address - Country:US
Mailing Address - Phone:405-464-3279
Mailing Address - Fax:
Practice Address - Street 1:1600 E US HIGHWAY 66
Practice Address - Street 2:SUITE #5
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-5787
Practice Address - Country:US
Practice Address - Phone:405-464-3279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health